Traumatic Brain InjuryFocus on Concussions

Presenters:William Thoreson

& Sarah BoninImage : http://en.wikipedia.org/wiki/Traumatic_brain_injury

Traumatic Brain Injury in Sports

http://www.youtube.com/watch?v=rapohLQ0UJw

Here is what I can expectSymptoms of Post-concussion Syndrome

Symptom Percentage Sleep difficulties 80% Poor concentration 71% Irritability 66% Fatigue 64% Depression 63% Memory problems 59% Headaches 59% Anxiety 58% Trouble thinking 57% Dizziness 52% Blurry or double vision 45% Sensitivity to bright light 40%

www.mentalhealth.va.gov/docs/tbi.pdf

What can my family expect?

• Remember to be patient with your injured family member

• For each step forward it may seem that there are 2 steps backward

• The family member will be unpredictable and so the family should have a predictable routine

• Repetition of procedures, skills, and communication is needed

What does the future hold?

• For concussion the future is bright– Almost full recovery within months is normal

• For severe TBI the future is uncertain– Relearning – Relapsing– Dr. appointments and rehabilitation– Frustration & hope

Images: http://minerva.union.edu/smithj2/howitworks1.htmhttp://www.clipartillustration.com/clipart-illustration-orange-man-holding-question-mark/

Types of Traumatic Brain Injury (TBI)

• TBI is characterized by A bump, blow, or jolt to the head that disrupts normal functioning of the brain. It can be acute or sustained.

• 2 Categories • Closed TBI- all damage in contained inside

skull• Open (penetrating) TBI- object penetrates

through skin & skull leaving an open wound

How common is TBI?

• 1.7 million people are annually diagnosed with a TBI

• 75% of TBI are concussions (mild TBI)

Rates in men

0-4 yr. old male children

Severity of Injury

• Concussion or mild TBI- brief change in mental status or consciousness

• Severe TBI- extended period of unconsciousness or amnesia

Mechanisms: 3 Current Ideas• *Membrane Poration*- membranes stretch

causing a separation which increases calcium movement into the cell.– Calpain(a protease) is activated which sets into

motion the degradation of cytoskeletal proteins in axons.

• Integrin Mediation-integrins hold cells in intracelluar matrix and pull on neurons with jarring motions causing neuron pull-back and membrane sheering or tearing and calcium ions move in.– Calpain is activated

Mechanisms: 3 Current Ideas

• Changes in ion channel receptors by changes in gene expression. Increase in #’s of receptors for NMDA & AMPA which increase basil levels of calcium in the cell.– This may be linked to delayed onset of symptoms

• Current thought is that concussion is a combination of the mechanisms above.

Interview with Dr. Patrick Alford

Types of Injuries that cause TBIImage: htt

p://ww

w.cdc.gov/Traum

aticBrainInjury/causes.html

If you notice an of these symptoms consult a doctor immediately!

            

Onset of symptoms in hrs., days, weeks, months, or longer

Short & Long-term functional changes to the Frontal & Temporal Lobes

• Normal Temporal Lobe Function

• recognizing and processing sound

• understanding and producing speech

• various aspects of memory

• Temporal Lobe Problems

• hearing loss• language problems• sensory problems like

the inability to recognize a familiar person’s face

Short & Long-term functional changes to the Frontal & Temporal Lobes

• Normal Frontal Lobe Function– planning– organizing– problem solving– memory– impulse control– decision making– selective attention– controlling our behavior

and emotion

• Frontal Lobe Problems– emotions– impulse control– language– memory– social and sexual

behavior

Concussion Treatments• Diagnosis sometimes difficult – young children,

culture (be tough)• Recovery depends on many factors– Severity of concussion– Age– Overall health

• Rest • Stay away from activities that could reinjure• Minimize drugs and alcohol• Heal completely to prevent long term problems

Strategies for Treatments or Cures• Concussion prevention is most emphasized– CDC “Heads-Up” Program– Coach, Player, and Parent Education Programs– Improved technology – Helmets, mouth guards– Baseline Testing

• Test before season, then before returning to play• Severe Traumatic Brain Injury– Brain Trauma Foundation in-hospital guidelines (CDC)

• 50% decrease in deaths• Save $288 million in medical and rehabilitation• $3.8 billion in lifelong social costs

Ethical Questions

• Baseline testing– Is it reliable?– Cost?– School/District, League Policy

• Rule Changes in Sports/Culture – NFL, NHL, MSHSL, NCAA

Links to Other Problems

• Shaken Baby Syndrome• Leading cause of child maltreatment deaths in US

• Chronic Traumatic Encephalopathy – CTE– Degenerative and progressive disease that comes

from too many hits to the head– CTE has been found in the brains of retired players

who have killed themselves– Symptoms include confusion, impaired judgment,

impulse control problems, aggression, depression, and progressive dementia – Boston University

Why did Junior Seau kill himself? Exploring athletes and depression Read more: http://sportsillustrated.cnn.com/2012/wdepressionriters/the_bonus/07/02/retired-athletes-/index.html#ixzz22xnDhqYv

Derek Boogaard: A Brain ‘Going Bad’http://www.nytimes.com/2011/12/06/sports/hockey/derek-boogaard-a-brain-going-bad.html?pagewanted=all

Center for the Study of Traumatic Encephalopathy, Boston University

Impact for Learning

• Can be huge due to high percentage of young people affected

• Lack of diagnosis for various reasons can lead to learning problems

• Lack of understanding on the importance of recovery can result in returning to school or sport to soon

• All Information from CDC unless otherwise notedhttp://www.cdc.gov/TraumaticBrainInjury/index.html